medicine – Rewirehttps://rewire.news
News, commentary, analysis and investigative reporting on reproductive and sexual health, rights and justice issues.Tue, 26 Sep 2017 20:04:40 +0000en-UShourly1https://wordpress.org/?v=4.8.2When Life-Saving Drugs Stop Working: UN Takes Look at Antimicrobial Resistancehttps://rewire.news/article/2016/09/28/un-antimicrobial-resistance/
Wed, 28 Sep 2016 18:03:18 +0000http://rewire.news/?post_type=article&p=94436Only two new antibiotics were approved in the United States between 2008 and 2012. And that's a big problem, as more and more illness-causing germs are getting harder to treat with existing medications.

]]>Last week, the United Nations General Assembly met to discuss the growing global issue of antimicrobial resistance. This marked only the fourth time a UN high-level meeting convened about a health topic, putting the issue on par with the AIDS pandemic and Ebola as threats to the health and economies of nations around the world.

Drug-resistant infections—in which illness-causing bacteria, viruses, or parasites no longer respond to medications—kill an estimated 700,000 people around the world each year and could cause 300 million premature deaths by 2050. Those numbers have caught the attention of world leaders, who used the meeting to call for improved prevention efforts and better systems to monitor overuse of antibiotics in medicine and agriculture. The member nations also noted pharmaceutical companies’ failure to deliver new affordable antibiotics and asked governments to create incentives to promote research and development.

While the United Nations’ consideration of the issue is groundbreaking, antibiotic resistance is not new. Almost as soon as scientists discovered ways to kill them, bacteria began to adapt. In fact, Alexander Fleming, who is credited with discovering penicillin, warned of resistance when he accepted a Nobel Prize in 1945: “There is the danger that the ignorant man may easily underdose himself and by exposing his microbes to nonlethal quantities of the drug make them resistant,” Fleming said. In recent years, the number of bacteria that has become resistant to the drugs commonly used to cure infections has increased, and the threat of untreatable infections looms large.

The threat, however, goes beyond just health. The World Bank recently released a report suggesting that if antibiotic resistance is not curbed soon, the crisis would make it impossible to reach the UN’s sustainable development goals for 2030.At the meeting, World Bank President Jim Yong Kim said: “The scale and nature of this economic threat could wipe out hard-fought development gains and take us away from our goals of ending extreme poverty. We must urgently change course to avert this potential crisis.”

Simply using antibiotics inevitably leads to resistance, but this crisis could be stemmed if we limited our use of these life-saving drugs. Antibiotics should only be used to fight diagnosed bacterial infections, but patients often demand antibiotics when they are not necessary and frequently stop those that are necessary too soon. When antibiotics are used, doctors need to prescribe the right medication in the right dose. But, unfortunately, doctors are limited by a lack of diagnostic testing that can determine which bacteria are causing infection. The result is that, according to the Centers for Disease Control and Prevention (CDC), 50 percent of the time antibiotics are not optimally prescribed.

Overuse of antibiotics in patients, however, may not be the main source of resistant germs. For decades, farmers have been using antibiotics in animals to fatten cows, pigs, and chickens faster and prevent infections from spreading among the animals. These antibiotics kill or suppress those bacteria that still respond to the drugs while resistant bacteria are allowed to thrive.

Some of the bacteria that are most resistant to existing drugs cause food-borne illnesses such as salmonella or sexually transmitted infections. Other bacteria of concern include methicillin-resistant Staphylococcus aureus (MRSA), which can live on medical equipment and is common in hospital settings. And, as Rewire has been reporting for many years, Neisseria gonorrhoeae, the bacteria which causes gonorrhea, is also becoming rapidly immune to existing treatments. In fact, at a meeting held in Atlanta at the same time the UN was meeting in New York, the CDC announced that seven men in Hawaii were infected with strains of gonorrhea that were showing resistance to the only two drugs we have left to treat it.

The lack of antibiotics in our arsenal is a large part of the problem the UN is attempting to address. Indeed a new report in the Journal of the American Medical Association (JAMA) points out that the FDA approved only two new antibiotics in the United States between 2008 and 2012. In contrast, it approved 16 new drugs between 1983 and 1987.

To be sure, a U.S. government incentive program—which speeds up the regulatory process—does seem to be working. As of March of this year, 37 new drugs were reportedly in development.

But for the pharmaceutical industry’s part, the JAMA report notes that it has not invested in antibiotic development primarily due to financial reasons.These drugs are expensive to produce and difficult to test because infections are sporadic and patients are usually exposed to existing antibiotics before being given an experimental drug. The profit motive is also not there; antibiotics are relatively inexpensive per dose and only taken for a short period of time as opposed to drugs designed to treat chronic conditions. Moreover, because the threat of resistance looms over any new antibiotic, the longevity of these drugs in the market is never certain.

At the conclusion of the UN meeting, all 193 member countries signed a declaration in which they promised, among other things, to encourage innovation and the development of new antibiotics. The declaration does not set targets but instead requires each country to submit a plan to the UN Secretary General within two years. This was done in part to acknowledge the disparities between signatory nations; in some countries, access to antibiotics when needed is a bigger problem than overuse and the UN does not want to stigmatize or impede necessary use of these drugs.

Ramanan Laxminarayan, director of the nonprofit Center for Disease Dynamics, Economics and Policy and a speaker at the meeting, told National Geographic that the road forward will not be easy and the stakes are high: “This is a multisector problem, which means the U.N has to quickly make friends outside of governments. We’ve got to get doctors, the whole medical practice community, the pharmacists, manufacturing, the whole agricultural sector …. We only get one crack at this. If we fail to do this, the world will only have checked off a box that says, ‘We have dealt with antimicrobial resistance, it went to the U.N., it is done.’”

]]>Sexual Health Roundup: The Sexual Power of Penicillin, the Importance of the First Time, and Testosterone Releasehttps://rewire.news/article/2013/01/30/sexual-health-roundup-sexual-power-penicillin-importance-first-time-and-testoster/
https://rewire.news/article/2013/01/30/sexual-health-roundup-sexual-power-penicillin-importance-first-time-and-testoster/#respondWed, 30 Jan 2013 18:49:15 +0000In this week's sexual health roundup: A pill may have led to the sexual revolution, but it was penicillin - not birth control; new research says the first time a person has sex really is important; and testosterone release is immediate upon mutual attraction.

]]>A Pill May Have Led to the Sexual Revolution, But it Wasn’t *The* Pill

A common refrain since the 1960s has suggested that the birth control pill was responsible for the sexual revolution. The argument tends to propose that the new-found control over their fertility took away the fear of pregnancy and gave women the freedom to explore their sexuality. A new analysis from economists at Emory University challenges this long-held notion and suggests that another pill—penicillin—was actually responsible for a more gradual increase in sexual behavior during the 50s and 60s. The analysis published in the Archives of Sexual Behavior points to the decrease in syphilis during the late 50s as the true beginning of the change in sexual norms.

In its primary and secondary phases syphilis causes sores on the mouth, vagina, or anus and rashes to appear elsewhere in the body. When it reaches its later stages, however, syphilis can cause a host of serious health problems including difficulty coordinating muscle movements, paralysis, numbness, blindness, and dementia. It can also damage everything including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Ultimately, this can lead to death.

Penicillin, which can easily cure Syphilis if taken early, was invented in 1928 but not used clinically until 1941 when the military began using it treat infected World War II soldiers. Syphilis reached its peak in the United States in 1939 when it killed 20,000 people. As the use of penicillin grew, the incidence of and deaths from the disease shrank rapidly; from 1947 to 1957 the incidence fell by 75 percent and the death rate fell by 95 percent.

Andrew Francis, who conducted the analysis, theorized that the lifting of the fear of syphilis and death led to more risky sexual behavior in this country. He based this theory on simple economic principles:

People don’t generally think of sexual behavior in economic terms but it’s important to do so because sexual behavior, just like other behaviors, responds to incentives.

To test his theory, Francis looked at data from the 1930s through the 1970s on three measures of sexual behavior: illegitimate births; teen births; and gonorrhea. He found that:

As soon as syphilis bottoms out, in the mid- to late-1950s, you start to see dramatic increases in all three measures of risky sexual behavior.

Francis noted that the parallels between this and the changes in sexual behavior around the AIDS epidemic—safer sex increased when the disease was at it scariest but the advent of antiretroviral therapies has led to decreased the risk and complacency. In fact, some of this complacency has undermined efforts to eliminate syphilis which seemed possible just a few years ago until the incidence began to rise again, especially in men who have sex with men.

Policy makers need to take into consideration behavioral responses to changes in the cost of disease, and implement strategies that are holistic and longsighted. To focus exclusively on the defeat of one disease can set the stage for the onset of another if preemptive measures are not taken.

New Research says the First Time is Important

I’ve always resisted our society’s fixation on virginity and the “first time.” It probably comes from the years I spent reading abstinence-only-until-marriage curricula which refer to virginity as a “present” that can only be unwrapped once and suggest that doing it on any night other than your wedding night (which by the way is the most important day of your life) will be a disaster and ruin the experience, the wedding, and, most importantly, you. While I will never belief virginity is something you give to someone else, there is some good research that suggests your first experience is important.

New research in the Journal of Sex and Marital Therapy suggests that a positive first time can set one on a course toward a happy sex life whereas negative experiences can lead to depression and other issues. Researchers at the Universities of Tennessee and Mississippi recruited 206 women and 113 men. They asked participants about the first time they had sex. Possible word associations included “anxiety,” “negativity,” “connection,” and “afterglow.” The also asked participants to rate how content they were with the experience or how much they regretted it. Researchers then turned to participants’ current sex lives asking them about satisfaction, general well-being, and sense of control. Finally, participants kept a sex diary in which they recorded their feelings about all sexual interactions.

The result found that positive first times “reliably predicted physical and emotional satisfaction in later sexual interactions.” Similarly, those who experienced anxiety and negativity during their first time were more likely to have lower overall sexual functioning.

The authors note that: “These results suggest that one’s first-time sexual experience is more than just a milestone in development. Rather, it appears to have implications for their sexual well-being years later.”

As writer Lindsay Abrams points out on Atlantic.com, however, these participants were still young and that first experience was really not that long ago (at most seven years and at the least a few months). There are still years of sexual experiences ahead of them and it’s not clear whether this association with the first time will continue as it becomes a more distant memory.

Speed Dating Boosts Testosterone

I was already married when the speed dating craze began but it always seemed like fun to me. I can imagine that presenting your best, most- interesting self, over-and-over again, could be an adrenaline rush (exhausting but fun). New research suggests that it also causes a rush of hormones.

Researchers at the University of Michigan recruited 200 heterosexual men and women who participated in approximately 2,000 speed dates. Volunteers had their testosterone levels checked using a saliva swab two weeks before the date, then right before the date, and finally right after. The results are interesting: if both people on the date were attracted to each other, their testosterone levels went up. A one-sided attraction, however, did not result in higher testosterone levels.

Though these are preliminary results, the researchers theorize that the hormone may be released to “promote efforts toward establishing a relationship with the other person.” What I find most impressive, though, is our internal sense of when someone is returning our interest. We may try to kid ourselves that he or she might like us, but our pituitary glands seem to know right away.

]]>https://rewire.news/article/2013/01/30/sexual-health-roundup-sexual-power-penicillin-importance-first-time-and-testoster/feed/0“Right to Professional Medical Judgment Act,” Crafted by Doctor, Introduced in Alabamahttps://rewire.news/article/2012/03/16/alabama-senator-coleman-introduces-right-to-professional-medical-judgement-act-sp/
Fri, 16 Mar 2012 15:15:28 +0000A bill to guarantee patients a right to get honest medical information and judgment from their doctors is being sponsored by Alabama Senator Linda Coleman. It was introduced only yesterday but has already been used as an amendement to an extreme anti-choice bill in Wisconsin.

In response to Alabama’s forced vaginal ultrasound bill, Abston posted a video expressing her outrage, as a doctor and woman, over the power grab by GOP extremists to act as elected physicians.

I wrote a piece on her video at Rewire shortly after the video posted. During an initial phone conversation with Abston she mentioned in passing that she was working on a piece of legislation that could potentially be taken up in the Alabama Legislature. I asked her if it was the first piece of legislation she had drafted. She laughed out loud for about fifteen seconds and told me, “yes!”

(Anyone anywhere can write a bill, circulate it to appropriate local, state or federal officials for review and possible sponsorship – Pippa’s original draft was only one paragraph long).

Alabama SB 413, the “Right to Professional Medical Judgment Act” was read for the first time March 15 and referred to the Alabama Senate Judiciary Committee. Senator Linda Coleman, who, as we reported, fought Alabama’s forced ultrasound bill as a “rape” bill, is the legislative sponsor of the new “right-to-medical-judgment” bill.

Abston is a bit of a reluctant activist, not because she doesn’t posses a well-educated fire for women’s reproductive health care, but because she is just blown away that Alabama and so many other states are seeking to trump doctors by inserting legislators between a woman’s legs.

“Well, I agreed to do one television interview and I thought it could be kinda risky, but since I don’t even know how to do an abortion I figured speaking out against the ultrasound bill would be okay,” Said Abston of the initial media attention she got from her outspoken video.

Her decision to come out publicly was not an easy one. Abston is already an advocate for single payer and mental illness and wasn’t sure she wanted to take on something she was afraid she wouldn’t have time for. Abston said, “I thought I might get in over my head, and I might have done so! But I’m glad I did it anyway and in the process got connected to some folks I never might have met otherwise, it is definitely worth doing.”

The climate for doctors to come out against the Alabama forced ultrasound bill can pose risks.

“When I told people even in my clinic that I was going to speak out about it there seemed to be a look of fear in their eyes,” said Dr. Abston.

The fear exists due to potential loss of patients over speaking out or, as is more likely, fear of extremists. “These people can be incredibly volatile,” said Abston of some anti-choice activists in Alabama. But, she is quick to point out that that volatility should not keep us from pushing back against them.

The legislation Abston wrote, and Senator Coleman introduced, utilizes neutral language and does not address any particular field of medicine in the text. Nor should it according to Abston. Although her decision to write the draft was triggered by the forced ultrasound bill the biggest issue is cutting the doctor off at the knees; the government forcing him or her to act in unethical or medically unnecessary way.

This from HB 413:

No physician or health care provider licensed to practice in the State of Alabama shall be forced by state or local regulatory authority to perform any medical service or component of medical service if the service or component of service is not medically necessary or would be harmful to the patient and the patient does not desire the medical service. The right to practice within the scope of a medical license supersedes any existing or future legislative act.

Last night, I found out that Democratic Wisconsin Representative Sandy Pasch introduced what I have started calling the Abston Amendment, in the form of a table amendment that was built directly from Abston’s draft.

With the support of other representatives Pasch, an RN and bio-ethicist, introduced the amendment to the misleading “anti-coercion” bill that in reality was crafted to keep tele-med abortion services out of Wisconsin.

I spoke with Pippa last night to let her know the spirit of her bill was picked up by Wisconsin women fighting against the surprisingly large number of governmental pseudo doctors. She was thrilled all she could say at first was, “What? Really!”

But the discussion turned to the need to implement bills like this around the country establishing – as if it needs to be established – the propriety of doctor and patient as the only authors of that patient’s care.

I spoke with a representative of Planned Parenthood Wisconsin who sat through over 26 hours of legislative sessions in the past two days. Once Pasch’s amendment was read, there was only about 10 minutes of debate and then it was soundly voted down. Planned Parenthood echoed the same sentiment as Abston – that action is needed to protect the rights of women seeking reproductive health care in statehouses across the country.

It wouldn’t hurt if this kind of bill was introduced in DC for that matter.

The legislature reconvenes on March 20. It is unclear how the debate will go around this non-controversial piece of legislation – or if it will make it out of committee. Observers of this bill should watch for public hearing schedules for the Judiciary committee on SB 413 after the legislature reconvenes next week.

]]>Midwife vs. midwifehttps://rewire.news/article/2009/07/19/midwife-vs-midwife/
Sun, 19 Jul 2009 11:14:06 +0000I am so deeply saddened by the American College of Nurse Midwives'
decision to fight the inclusion of Certified Professional Midwives in
health-care reform.

]]>I am so deeply saddened by the American College of Nurse Midwives’
decision to fight the inclusion of Certified Professional Midwives in
health-care reform.

I have a lot of respect for the work of
Certified Nurse-Midwives (CNMs), who are trained as RNs and go on to
pursue graduate-level education in midwifery, similar to a
Nurse-Practitioner or ARNP. Most practice in hospitals under the
supervision of an obstetrician, and they are recognized in all 50
states. Because of their status as medical professionals, CNMs are
able to both serve women who may never have heard or considered
out-of-hospital birth and receive reimbursement from insurance and
government-funded Medicaid programs. They provide humanized birthing
care within the hospital, often reducing intervention and improving
outcomes in poor or under-served communities. They are able to do
this, again, because they are legal recognized throughout the country
and by the federal government as health-care providers.

Certified Professional Midwives are not nurses. They are, I would argue, health care providers but not medical professionals.
For most healthy women, birth doesn’t need to be a medical event, and
what they need is primarily someone to safe-guard and support the
healthy choices they will make when given good information. CPMs
practice exclusively in out-of-hospital settings, including homes and
free-standing (i.e. not hospital affeliated) birth centers. They
recieve the CPM credential after demonstrating that they have an
agreed-upon set of skills which are necessary to facilitate normal
birth and manage the rare emergency. Their training takes place primarily outside the hospital, allowing them to approach birth from the perspective of normalcy rather than from the perspective of medical emergency. Unfortuanately, in many states,
CPMs are not recognized health care providers. Their clients must pay
out-of-pocket for services, their access to medical referral is
limited, and their practice is sometimes tolerated by Attorneys General
who choose not to prosecute them for practiing medicine without a
license. Thus, though many healthy women could be good candidates for
out of hospital birth, they have never heard of CPMs or are too poor to
pay for their care.

Health care reform could change all that.
If the CPM was recognized as a health care provider by the federal
Medicaid program, out of hospital birth care could spread to women who
now could only be served by doctors and nurse-midwives, and the stage
would be set for incorporation of CPMs into the health care system
nationwide.